| Question | Answers | Source | Source Link | Dates Used | |
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| 1 | Prior to the coronavirus (COVID-19) pandemic, for the following questions, please indicate how often you were concerned about the following regarding your child(ren) between the ages of 0-5. • Getting poor care and education • Being mistreated by adults • Getting stopped in a white neighborhood • Being punished more harshly than others • Being discouraged from trying new things • Being considered less attractive • Having fewer choices in life • Being excluded from events or groups • Being treated unfairly by other children | • Never • Rarely • Some of the time • Most of the time | Modified by RAPID Team and RISER Team Development and reliability of a telephone-administered perceived racism scale (TPRS): A tool for epidemiological use. Ethnicity & Disease, 11, 251–262. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886583/ | 08/24/2020-08/27/2020 10/05/2020-10/08/2020 09/08/2020-09/10/2020 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 11/17/2020-11/19/2020 12/01/2020-12/03/2020 12/15/2020-12/17/2020 01/05/2021-01/07/2021 02/03/2021-02/06/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 11/10/2021-11/16/2021 12/08/2021-12/14/2021 01/11/2022-01/18/2022 01/03/2022-01/24/2022 |
| 2 | Since the coronavirus (COVID-19) pandemic, for the following questions, please indicate how often you were concerned about the following regarding your child(ren) between the ages of 0-5. • Getting poor care and education • Being mistreated by adults • Getting stopped in a white neighborhood • Being punished more harshly than others • Being discouraged from trying new things • Being considered less attractive • Having fewer choices in life • Being excluded from events or groups • Being treated unfairly by other children | • Never • Rarely • Some of the time • Most of the time | Modified by RAPID Team and RISER Team Development and reliability of a telephone-administered perceived racism scale (TPRS): A tool for epidemiological use. Ethnicity & Disease, 11, 251–262. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886583/ | 08/24/2020-08/27/2020 10/05/2020-10/08/2020 09/08/2020-09/10/2020 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 11/17/2020-11/19/2020 12/01/2020-12/03/2020 12/15/2020-12/17/2020 01/05/2021-01/07/2021 02/03/2021-02/06/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 11/10/2021-11/16/2021 12/08/2021-12/14/2021 01/11/2022-01/18/2022 01/03/2022-01/24/2022 |
| 3 | Please indicate whether you have experienced any of the following prior to the coronavirus (COVID-19) pandemic • Did you ever receive service from someone such as a plumber or car mechanic that was worse than what other people get because of your race or ethnicity? • Were you ever denied service because of your race or ethnicity • Were you ever unfairly stopped, searched, questioned, physically threatened, or abused by the police because of your race or ethnicity? • Were you ever unfairly fired because of your race or ethnicity? • For unfair reasons, were you ever not hired for a job because of your race or ethnicity? • Were you ever unfairly denied a promotion because of your race or ethnicity? • Were you ever unfairly discouraged by a teacher or advisor from continuing your education because of your race or ethnicity? • Were you ever unfairly prevented from moving into a neighborhood because the landlord or relator refused to sell or rent you a house or apartment because of your race or ethnicity? • DId you ever move into a neighborhood where neighbors made life difficult for you or your family because of your race or ethnicity? • Were you ever unfairly denied a bank loan because of your race or ethnicity? • Were you ever denied medical service because of your race or ethnicity? • Were you ever called an insulting and derogatory term because of your race or ethnicity? | • Yes • No • Not applicable | Modified by RAPID Team and RISER Team Perceived Discrimination, Race and Health in South Africa: Findings from the South Africa Stress and Health Study. Social Science and Medicine, 2008; 67: 441-452. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643465/ | 08/24/2020-08/27/2020 10/05/2020-10/08/2020 09/08/2020-09/10/2020 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 11/17/2020-11/19/2020 12/01/2020-12/03/2020 12/15/2020-12/17/2020 01/05/2021-01/07/2021 02/03/2021-02/06/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 11/10/2021-11/16/2021 12/08/2021-12/14/2021 01/11/2022-01/18/2022 01/03/2022-01/24/2022 06/02/2022-06/09/2022 07/08/2022-07/15/2022 08/02/2022-08/11/2022 09/08/2022-09/15/2022 10/05/2022-10/12/2022 |
| 4 | Please indicate whether you have experienced any of the following since the coronavirus (COVID-19) pandemic • Did you ever receive service from someone such as a plumber or car mechanic that was worse than what other people get because of your race or ethnicity? • Were you ever denied service because of your race or ethnicity • Were you ever unfairly stopped, searched, questioned, physically threatened, or abused by the police because of your race or ethnicity? • Were you ever unfairly fired because of your race or ethnicity? • For unfair reasons, were you ever not hired for a job because of your race or ethnicity? • Were you ever unfairly denied a promotion because of your race or ethnicity? • Were you ever unfairly discouraged by a teacher or advisor from continuing your education because of your race or ethnicity? • Were you ever unfairly prevented from moving into a neighborhood because the landlord or relator refused to sell or rent you a house or apartment because of your race or ethnicity? • DId you ever move into a neighborhood where neighbors made life difficult for you or your family because of your race or ethnicity? • Were you ever unfairly denied a bank loan because of your race or ethnicity? • Were you ever denied medical service because of your race or ethnicity? • Were you ever called an insulting and derogatory term because of your race or ethnicity? | • Yes • No | Modified by RAPID Team and RISER Team Perceived Discrimination, Race and Health in South Africa: Findings from the South Africa Stress and Health Study. Social Science and Medicine, 2008; 67: 441-452. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643465/ | 08/24/2020-08/27/2020 10/05/2020-10/08/2020 09/08/2020-09/10/2020 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 11/17/2020-11/19/2020 12/01/2020-12/03/2020 12/15/2020-12/17/2020 01/05/2021-01/07/2021 02/03/2021-02/06/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 11/10/2021-11/16/2021 12/08/2021-12/14/2021 01/11/2022-01/18/2022 01/03/2022-01/24/2022 03/07/2022-03/16/2022 |
| 5 | Prior to the coronavirus (COVID-19) pandemic, • Did you talk to your children about challenges they may face because of their race or ethnicity? • Did you talk to your children about advantages they may face because of their race or ethnicity? | • Yes • No • Not applicable | Modified by RAPID Team and RISER Team Race in America 2019: Public has negative views of the country’s racial progress; more than half say Trump has made race relations worse. Washington, DC: Pew Research Center. | https://www.pewsocialtrends.org/2019/04/09/race-in-america-2019/ | 08/24/2020-08/27/2020 10/05/2020-10/08/2020 09/08/2020-09/10/2020 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 11/17/2020-11/19/2020 12/01/2020-12/03/2020 12/15/2020-12/17/2020 01/05/2021-01/07/2021 02/03/2021-02/06/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 11/10/2021-11/16/2021 12/08/2021-12/14/2021 01/11/2022-01/18/2022 01/03/2022-01/24/2022 03/07/2022-03/16/2022 06/02/2022-06/09/2022 07/08/2022-07/15/2022 08/02/2022-08/11/2022 09/08/2022-09/15/2022 10/05/2022-10/12/2022 |
| 6 | Since the coronavirus (COVID-19) pandemic, • Did you talk to your children about challenges they may face because of their race or ethnicity? • Did you talk to your children about advantages they may face because of their race or ethnicity? | • Yes • No | Modified by RAPID Team and RISER Team Race in America 2019: Public has negative views of the country’s racial progress; more than half say Trump has made race relations worse. Washington, DC: Pew Research Center. | https://www.pewsocialtrends.org/2019/04/09/race-in-america-2019/ | 08/24/2020-08/27/2020 10/05/2020-10/08/2020 09/08/2020-09/10/2020 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 11/17/2020-11/19/2020 12/01/2020-12/03/2020 12/15/2020-12/17/2020 01/05/2021-01/07/2021 02/03/2021-02/06/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 11/10/2021-11/16/2021 12/08/2021-12/14/2021 01/11/2022-01/18/2022 01/03/2022-01/24/2022 |
| 7 | Prior to the coronavirus (COVID-19) pandemic, for the following questions, please indicate how often you were concerned about the following regarding your child(ren) under the age of 6 years. • Getting poor care and education • Being mistreated by adults • Getting stopped in a white neighborhood • Being punished more harshly than others • Being discouraged from trying new things • Being considered less attractive • Having fewer choices in life • Being excluded from events or groups • Being treated unfairly by other children | • Never • Rarely • Some of the time • Most of the time • Not applicable | Modified by RAPID Team and RISER Team Development and reliability of a telephone-administered perceived racism scale (TPRS): A tool for epidemiological use. Ethnicity & Disease, 11, 251–262. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886583/ | 03/07/2022-03/16/2022 06/02/2022-06/09/2022 07/08/2022-07/15/2022 08/02/2022-08/11/2022 09/08/2022-09/15/2022 10/05/2022-10/12/2022 |
| 8 | Are you and all of your child(ren) of the same race/ethnicity? | • Yes • No • Do not wish to disclose | NA | 11/02/2023-11/09/2023 | |
| 9 | Are all of your children under the age of 6 years of the same race/ethnicity? | • Yes • No • Do not wish to disclose | NA | 11/02/2023-11/09/2023 | |
| 10 | What is the race/ethnicity of your oldest child under the age of 6 years? Select all that apply. | • White (e.g., German, Irish, English, Italian) • Hispanic, Latine, or Spanish origin (e.g., Mexican/Mexican American, Puerto Rican, Cuban, Dominican, Salvadoran, Colombian) • Black or African American (e.g., African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian) • Asian (e.g., Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese) • American Indian or Alaska Native (e.g., Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, Mayan, Doyon, Native Village of Barrow Inupiat Traditional Government) • Native Hawaiian or Other Pacific Islander (e.g., Native Hawaiian, Samoan, Guamanian or Chamorro, Tongan, Fijian, Marshallese) • Middle Eastern or North African (e.g., Lebanese, Egyptian) • Not Listed (please specify) | NA | 11/02/2023-11/09/2023 |